What Is a Posterior Tongue Tie, and Is It a Reason to Perform a Tongue Clip?

Columbus, OH — February 2018

Written by Jonathan Grischkan, MD, otolaryngologist at Nationwide Children’s Hospital and assistant professor at The Ohio State College of Medicine

“Tongue tie," or ankyloglossia, is a frequent concern among mothers of newborns, especially those planning to breast-feed. This condition results when a portion of the undersurface of the tongue (or anterior part) is tethered to the floor of mouth, or internal aspect of the lower gum (alveolus), limiting movement and function of the tongue.

The ability of the tongue to create a seal to express milk is dependent to a certain extent on the tongue’s mobility. Tongue tie is generally thought of as an anterior problem when it is attached to the internal aspect of the mandible (jaw). 

The posterior (or back) portion of the tongue is actually called the tongue base, and it is a necessary and normal anatomic structure. It is the majority of the tongue musculature and provides neurovascular supply to the tongue. In my opinion as an otolaryngologist, the concept of "posterior tongue tie" doesn't really make sense anatomically and is very rarely a true problem.

The decision to divide a tongue tie is generally made only in newborns for feeding concerns, or in kindergarten-aged children if they are having pronunciation or articulation speech difficulties. 

In our institution’s Otolaryngology clinic, we routinely perform lingual frenotomy (tongue clip) on newborns younger than 3 months of age, without the need for any anesthetic, special equipment or laser. There is essentially no blood loss from lingual frenotomy, and it is usually performed in less than 5 minutes in our office.

Upper lip tie does not usually cause feeding problems, and division is usually only indicated when the primary teeth descend if there is diastasis (separation) of the central incisors.

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